Injury
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Despite the use of modern implants, complications such as nonunion and avascular necrosis of the femoral head are observed in femoral neck fractures (FNF). We have created a new perforated I-beam implant for FNF osteosynthesis and developed a new osteosynthesis philosophy based not only on the mechanical and biomechanical interaction of the bone-implant system, but also on the interaction of the biological properties of the bone and the implant. The purpose of the work is to study the interaction of the biological process of the bone - its regeneration (germination) of bone tissue into the holes of the implant. ⋯ The obtained results show the following: 1.The titanium implant is bioinert and does not cause any visible reactions from the bone tissue; 2. There is a gradual process of formation of new vessels, and then the formation of new bone tissue in the holes of the implant instead of the one damaged during implantation. Thus, the results of this experiment indirectly confirm our assumption that a perforated implant for FNF osteosynthesis will participate not only in the mechanical and biomechanical interaction of the bone-implant system, but will also include the 3rd element in this system - the biological properties of the bone itself. We assume that these properties of the new implant will increase blood flow in the femoral neck and partially replenish the volume of bone tissue destroyed during osteosynthesis which does not occur with FNF osteosynthesis by any of the known implants.
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Review Meta Analysis
Accuracy of prehospital triage systems for mass casualty incidents in trauma register studies - A systematic review and meta-analysis of diagnostic test accuracy studies.
Prioritising patients in mass casualty incidents (MCI) can be extremely difficult. Therefore, triage systems are important in every emergency medical service. This study reviews the accuracy of primary triage systems for MCI in trauma register studies. ⋯ As the included studies were at risk of bias and had heterogenic characteristics, our results should be interpreted with caution. Nonetheless, our results point towards inferior accuracy of Triage Sieve compared to START and CareFlight, and less firmly point towards superior accuracy of Military Sieve compared to START, CareFlight and Triage Sieve.
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Extensive soft-tissue defects around the ankle and foot pose a difficult challenge to surgeons. Considering that natural contour, the ideal solution should match a thin and pliable skin flap to allow shoe fitting and provide a functional move. As the conjoined flaps were increasingly utilized in covering various defects, we present our experience using the bipedicle conjoined flap on the lower abdomen and groin site. ⋯ Bipedicle conjoined flap harvested from the lower abdomen and groin is a great alternative, in selected patients seeking one-stage coverage for the exposed ankle and foot. Compared to single-pedicle flaps, the increased skin allows the wider coverage for the large defect with less morbidity and better outcomes.
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Observational Study
Post-discharge rehabilitation and functional recovery after pediatric injury.
Variability in rehabilitation disposition has been proposed as a trauma center quality metric. Benchmarking rehabilitation disposition is limited by a lack of objective measures of functional impairment at discharge. The primary aim of this study was to determine the relative contribution of patient characteristics and hospitalization factors associated with inpatient and outpatient rehabilitation after discharge. The secondary aims were to evaluate the sensitivity of the Functional Status Scale (FSS) score for identifying functional impairments at hospital discharge and track post-discharge recovery. ⋯ Injury characteristics and discharge impairment were associated with discharge to inpatient rehabilitation. The FSS score identified impairments needing inpatient rehabilitation and characterized improvements after discharge. Less severe impairments needing outpatient rehabilitation were not identified by the FSS score.
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Cannulated screws are often used in the management of open lower extremity fractures. These fractures exhibit broad contamination profiles, necessitating empirical Gram-positive and Gram-negative antibiotic coverage. To ensure full antibiotic protection of the cannulated screw and the bone tissue, it is generally accepted that target tissue antibiotic concentrations, as a minimum, reach and remain above relevant epidemiological cut-off minimal inhibitory concentrations (T>MIC) for a sufficient amount of time. ⋯ We found short T>MIC, particularly for the high MIC targets for vancomycin and meropenem, both inside the cannulated screw and in cancellous bone adjacent to the screw. The presence of a cannulated screw impaired the penetration of especially vancomycin into cancellous bone adjacent to the screw. More aggressive or different vancomycin and meropenem approaches may be considered to encompass contaminating differences and to ensure a theoretically more sufficient antibiotic protection of cannulated screws when used in the management of open lower extremity fractures.